Glass of Water Emptying:  The Way I Explain the Aging of the Face

When people ask me whether fat grafting is permanent, I say yes and no.  Yes, it is permanent because if done well by an expert injector (which I consider myself one) then once the graft gains formal blood supply over a period of several months to a year, the graft is yours to keep.  My mother, for example, is over 5 years out and still looks much younger than before she had the fat transfer but clearly she has had some degree of ongoing aging.  The “No” response to permanence refers to this latter issue that a fat transfer does not stop aging but keeps one forever at least at a relatively younger look and age than would have been present if one never did it.  I use the example of two identical twins, one of whom is way over 5 years out from fat and who still looks at least 10 to 15 years younger than her sibling who never had it done.  However, she has aged over the period of time that has elapsed since she had the fat transfer.  In the photograph I show of the twins that ongoing aging is still quite negligible overall.

Using the model of a glass of water, I explain that aging is about volume loss principally (and to a lesser extent neck sagging, wrinkles, etc.).  I explain that in youth an individual is almost too full (so-called baby fat) but in aging they are too empty so aging is like a glass of water emptying.  Filling someone up with a permanent filler like fat allows one to tank up the glass of water to the ideal level but over time that glass of water continues to empty.  That is how I try to explain the concept that fat grafting is permanent but does not stop the aging process.

Hair transplants are very similar to fat transplants since both are free grafts that hold very well over time and tend to resist the aging process, i.e., the transplanted grafts typically do not dissipate.  However, the hair or fat around the transplant in the areas that are genetically programmed for hair loss or aging with fat loss will be lost over time and need to be replaced.  Accordingly, hair transplants are permanent but they do not stop the process of male pattern baldness.  I hope this helps one understand how fat grafts are permanent but may require touch ups down the road.  Typically, what I do for patients is perform fat transfers and then every year do a small filler touch up to keep them “tanked up” and stave off the aging process from continuing along its otherwise inexorable course.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum